Brenda J.

Interpret program regulations and other pertinent material to applicants for calfresh/medi-cal. Maintain a focus on meeting the needs of internal and external customers; develop and maintain effective relationships with others; relate well to people from varied backgrounds and in different situations; show understanding, courtesy, tact, empathy, concern, and politeness. Obtain necessary information during phone and in-person interviews by establishing data collection, explaining the purpose of the interview, responding to customer concerns/questions, and/or asking appropriate follow-up questions. Compute amount of income, expenses, deductions & household size to determine & authorized cases. Write information, using accurate grammar, in a manner that is clear, well-organized, and follows a logical progression to ensure the writing is tailored to the intended audience or purpose. Use external systems, applications, search engines, and databases, including web browsers and web-based information systems to conduct research in order to determine and/or verify eligibility. Prepare and maintain other documents associated with the eligibility determining process. On the basis of denial; provide the client with other resource

Answered and responded to inbound patient calls in a Call Center environment. Investigated and conducted root cause analysis for inquiries received from patients and patient representatives. Responsible for accurately documenting steps taken and next steps needed to provide resolution. Coordinated with facilities, payors and collections agency related to a patient account. Reviewed and resolved patient concerns, which include: demographic updates, insurance coverage, resubmitting claims, appeal requests, payments and collection cancellation notice. Reviewed patient accounts, claim information and Explanation of Benefits to enable quick resolution of patient issues. Drafted communications to patients, patient representatives, payors, and vendors as needed. Assisted in responding to legal and financial assistance requests. Maintained various email accounts to ensure patient concerns are properly addressed in a timely manner. Evaluated customer service processes and provide feedback on improvement plan. Reported on status of patient concerns, trends, and resolutions to the management team.

Reviewed Mortgage documents, title loans & Auto loans document for completeness and accuracy. Verified all documents contain a transmittal & shipping label. Prepared, compile and sore documents for data entry. Compared information in the system against the information listed on the actual document. Verified data and corrects data where it's necessary. Obtained further information for incomplete documents. Updated software with appropriate coding and deletes unnecessary codes. Combined and rearrange data from sources. Checked completed work for accuracy. Assisted coworkers and supervisor as needed. Used training skills to train new staff members. Responsible for answering any questions staff may have regarding work related. Responsible for auditing all new staff members work. Complied with data integrity and security polices. Operated photocopiers, scanners, software and computers. Store completed documents in boxes. able to lift 45 lbs/box

Maintained payment records of all patients Verified Insurance Eligibility; Medicare, Medicaid, Commercial insurances Submitted daily claims to insurance companies Checked benefits, Copayment, Deductible and Co-insurance Data Entry and Posted Upgrade fees Verified Pre-existing, waiting periods, SNF and HHC Used analytical skills to investigate the issues with unpaid claims or denied payment Verified Sleep Study (RDI & AHI 5+) and verified History & Physical notes Followed up with patients to make sure they were compliant with pap machine (Mc & Private ins) Reviewed authorization for rentals equipment daily Extended Rentals of pap device & processed appeals and grievances Ensured medical compliance by maintaining standards set forth by insurance and HIPAA Collected daily payments from insurance/patients and posted them onto Brightree software Answered patient/doctor calls Worked with accounts receivable department for invoicing patients. Faxed pts documentation to physicians when needed

Medicare and Commercial knowledge on billing and appeals techniques Data entry on processing payments and requisition forms Verified patient benefits/eligibility Work with payors on reviewing and resolving remittance errors and claim rejections. Address billing related calls from patients and physicians within a timely manner. Processed Claims and appeals submissions Research changes and updates to insurance plan specific claim and appeals processes and requirements. Establish ongoing contacts within the insurance plans Posted EOBS Knowledge and understanding of Healthcare industry Helped out with additional duties; Filling patient charts and helping out with receptionist Uploaded/Scanned patient demographics onto database system.

Maintained payment records of all patients Made payment arrangements and collected past due accounts Verified benefits for private Insurance, Medicare, Medical, CalOptima & W/C Daily aging reports Data Entry Qc'd/Audit requisition forms Faxed lab reports to physicians Answered patient/doctor calls Submitted online claims and billed electronic claims Processed appeals when appropriate to obtain maximum reimbursement

Provided customer service assisting and serving Responsible for hospitality services Prepared food trays to HHC patients Verified orders on color coded menu cards Obtained record of special orders for patients Collected and stacked dirty dishes on cart & returned cart to kitchen